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Monday, April 29, 2013

On the Road to New Beginnings in Uganda

Uganda is a contradiction. This beautiful lush east African country of 35 million is rich in minerals. With abundant rainfall and rich soils, you can grow practically anything. Uganda could feed Africa, people often say.

Yet, in a country that could be the breadbasket for the continent, malnutrition and stunting among children is common. Too many children in Uganda die before age five (it has one of the region’s highest child mortality rates). And though the country has relatively high primary school enrollment rates for both boys and girls (in the 90's), it also has very low completion rates. High incidence of debilitating infectious diseases like malaria and HIV/AIDS among children are leading causes of school absenteeism.

Why should a country endowed with so much be struggling like this? Years of civil war and insurgency have been a major factor. Uganda has experienced civil war and insurgency practically every decade since independence. Conflict has wreaked havoc with the economy, destroyed infrastructure and stolen the futures of millions of children and youth. Thousands of families have been displaced.
In more recent years conflict has subsided and economic governance improved. The currency has stabilized. And conflict, at least in the form of formal wars and insurrection, has subsided. Today, it has one of the better business climates in Africa. Investment flows are growing.

Plan in Uganda

Plan has been in Uganda since 1992. It started in districts like Luwero, an area that was the site of a fierce insurgency by the rebel group, National Resistance Army and a brutal counter-insurgency by the government of Milton Obote, known as the Ugandan Bush War/Luweero war or the "Bush War", that left many thousands of civilians dead during the early to mid-1980s.

In 2007 Plan started to move north to Lira as the conflict there subsided and the reconstruction began. Last year, with the help of a $50 million grant from the US Agency for International Development (USAID - the leading agency of the US Government responsible for foreign aid ), it started operations in Gulu covering 15 northern districts. Years of war have left Gulu and all districts in northern Uganda decimated, and thousands of displaced families exhausted and destitute. In a country with one of the lowest Human Development Index (HDI) rankings in the world, northern Uganda indicators are at the bottom of the bottom.

As Plan Uganda focuses now where the needs are the greatest, it is also starting to exit from districts, like Luwero. In my recent visit to Uganda I had an opportunity to see both: communities in Luwero with which Plan had been working for a long time, and in Gulu, where Plan had just started. The contrasts are instructive and I think illustrate well the value of Plan's child-centered community development approach.

Visiting Luwero

The community we visited in Luwero is very poor and isolated. Plan had been working with village leaders and local government to bring health, education and other services to the community. On the day we were there, there was a health clinic worker dispensing vitamin A to the children and another one giving a chat to parents about nutrition. The community leaders with whom we spoke were very pleased with what they had accomplished with Plan's support. They showed us an early childhood education center that Plan had helped them build, providing materials for the actual center (the community actually constructed the center) and training the volunteer care givers, helping to organize the center's management committee and encouraging all parents to become more engaged in their children's learning.

The center takes children aged 4 to 8 years and prepares them to be integrated in the formal school system. The parents proudly spoke of the difference this investment in early education had made for their children. Every parent noted their kids were doing much better in primary school than the children from more affluent communities. They also told us about other ways Plan had helped. For example, Plan had helped establish a village savings and loans group, providing a vehicle for parents to save and an additional safety net, so that medical emergencies did not become catastrophes or school fees an impediment to sending kids to school. Plan had worked with the local government, the families and the children, to develop a community-owned and community-led integrated package of activities meant to help children succeed. And it was bearing fruit.

Putting Gulu Back Together

The community we visited in Gulu district was literally putting itself back together again, as those displaced by the conflict came back to their homes. The family we visited is representative of the situation in the villages. The mother was HIV positive and had passed the infection to the older children, ranging in age from 9 to 5. The smaller two, twin girls less than 2 years of age, were HIV negative thanks to treatment they had received in the nearby health center some 3 kilometers away. This is of course great news, and she was very pleased. But the odds were certainly against them.

The mother told us that the little girls had been severely underweight when they were younger. She explained that they had no food; they had just moved back and had not had time to plant yet. And it is hard to plant and care for the kids when you yourself are sick. The health center, with which Plan worked, had provided special nutritional supplements and the little girls seemed to be thriving now; she was very relieved. But now she was worried about her older child. He had high fevers. It was probably malaria. The mother was hopeful. Access to care and medicine was easier now. But the family was clearly living on the edge.

Plan has plans for Gulu. Under the USAID-funded project, it is now working closely with district, county, and parish authorities to strengthen the network of providers, and improve the access to medical treatment and supplies. It is working with the communities themselves to, among other things, educate mothers on how to prevent HIV transmission, use insecticide treated bed nets to prevent malaria, and grow and eat enough nutrients to keep the children healthy.
Clearly the work that Plan had been doing with the local health clinics and with the village health worker (a volunteer trained to provide first aid and medical advice and referrals to the clinic) was having an impact.

But tackling the complicated web of economic and social stresses that make every day a struggle for this and many other recently resettled families in the district will require time, and patience. As the experience in Luwero illustrates, improving the conditions in Gulu is not about delivering medicines and services, but also about changing mind sets and altering how communities and authorities interact.

The Next Steps

Plan announced recently that it would be exiting Luwero in 2015. The Luwero district villagers and authorities were sad to see Plan leave. But they are also confident in their ability to continue to grow and invest in their future. This is what development and community ownership is about. This is our vision for Gulu. The USAID grant is the centerpiece of our work in the north. But it is a part of a broader effort to strengthen community-based services and enable children and their families in this conflict affected region realize their enormous potential.